Guest host Dr. Miriam Knoll, radiation oncologist at the John
Theurer Cancer Center at Hackensack Meridian Health, interviews
oncologists about the decisions and extraordinary moments that have
shaped their careers in this special podcast series. In this
episode, Dr. Knoll speaks with Dr. Suzanne Cole, director at
University Hospital Simmons Cancer Clinic at UT Southwestern
Medical Center, about her early-career leap of faith to move from
academia to a remote community oncology practice.

TRANSCRIPT:

Dr. Miriam Knoll: Welcome to the ASCO Daily News Podcast. I'm
Dr. Miriam Knoll and I'm delighted to be the Daily News guest host
for a special podcast series that explores a full spectrum of
oncology careers. I am an early career radiation oncologist. And in
this series, I'll bring you interviews with a wide range of
oncologists to hear about their diverse experiences, greatest
challenges, and the unforgettable moments that shaped their
careers.

Dr. Miriam Knoll: In today's episode, I'm thrilled to welcome
Dr. Suzanne Cole, a medical oncologist at UT Southwestern Medical
Center. She serves as a director of the University Hospital Simmons
Cancer Clinic at the UT Southwestern Medical Center at
Richardson/Plano. Dr. Cole and myself report no conflicts of
interest relevant to this podcast. Full disclosures relating to all
Daily News Podcast can be found on our episode pages. Dr. Cole,
welcome to the podcast.

Dr. Suzanne Cole: Thank you so much for inviting me.

Dr. Miriam Knoll: So I'm so excited to have you here. You and I
met on social media, which is becoming way more common nowadays.
Would you agree?

Dr. Suzanne Cole: I totally agree.

Dr. Miriam Knoll: So I'm going to ask you about the HEME/ONC
women's Facebook group a little bit later. But right now I first
wanted to ask you about your career trajectory. Because I know that
you first started off after you completed your training working in
the community and more recently joined UT Southwestern.

Dr. Suzanne Cole: That's true.

Dr. Miriam Knoll: How did that come about for you?

Dr. Suzanne Cole: So I think that my story is not unlike other
women who may be considering, you know, various options coming out
of fellowship as far as what do they want to do or where do they
see themselves. But I think I also had some kind of just normal
life family pressures that pushed me in a certain direction. So I
did my fellowship at MD Anderson.

Dr. Suzanne Cole: And when I went there, I thought I might be a
stem cell transplant doctor. And I spent my first year in clinic
kind of embedded in a transplant clinic and doing a lot of
inpatient. And, you know, I kind of learned during that time that
transplant probably wasn't the right fit for me. And I really
didn't love any particular other tumor type enough to kind of then
switch gears and dedicate my life to like one specific type of
cancer.

Dr. Suzanne Cole: And so I told my program that I thought I was
probably going to end up being a generalist and go back into the
community. Most of my family is in Dallas. And that's where I was
kind of hoping to land eventually. And I focused the last couple
years of my fellowship on just really getting a very broad
education in all of the tumor types.

Dr. Suzanne Cole: And then also, I think that this is important
for women and men, but I'm the breadwinner of my family. I have
four children. My husband is a musician. And when I was coming out
of fellowship, I was probably about $250,000 in debt. And my oldest
son was kind of getting close to needing to go to college.

Dr. Suzanne Cole: And, of course, like, I'd been in training and
med school and residency for most of his growing up. And I had
nothing set aside for his college. So I really needed to be in a
place where I could be in a situation where I could pay off my
loans and also save money for college. And, to be quite frank, a
lot of the entry level academic positions just would not allow me
to financially get my loans out of the way and also prepare for
college, which was coming in a very short period of time for my
oldest son.

Dr. Suzanne Cole: So I ended up taking a job in Charleston, West
Virginia, where I was able to kind of get a loan payment situation
taken care of. And I worked in this underserved area and was able
to, basically, get financially straightened out within the first
four years of my career. And it was a really fantastic place to cut
my teeth as an oncologist.

Dr. Suzanne Cole: Because I was working for a very large
hospital system called CAMC. And they have this network of
hospitals in Charleston that basically serves the entire southern
half of West Virginia. It's a huge patient population that filters
into this kind of safety net hospital.

Dr. Suzanne Cole: And when I joined that practice, I was one of
nine oncologists. So I had a lot of great partners to just help me
and mentor me. But we took care of anything that walks through the
door from acute leukemia to rare sarcomas to bread and butter
breast cancer, prostate cancer, colon cancer. And also benign
hematology, we had the hemophilia center for the state. And it was
a really fascinating, busy, very robust and varied type of first
practice.

Dr. Suzanne Cole: And I also was very fortunate that they had a
pretty well-developed community oncology research program. And I
was able to put patients on clinical trial, which was very
gratifying. Because coming out of fellowship at MD Anderson,
everybody was on trial. And I was very comfortable with having that
access to research and giving options to patients that was beyond
the standard of care. And so that was my first four years in
practice.

Dr. Miriam Knoll: Wow, so can you tell us more, you know,
logistically, you mentioned that you were looking for a certain
type of, you know, let's say loan repayment or job security and
compensation and that you were comparing your opportunities. You
know, did you, you know, work with a recruiter or did people reach
out to you? You know, what was that process like for you?

Dr. Miriam Knoll: Because I think a lot of our listeners
would be interested in hearing more about, you know, how does one
look for different types of job opportunities if they're
considering more than one type of practice? And I think that's
something that a lot of people don't really admit when they're
looking for a job. Because a lot of people say, "Oh, I'm only
looking for academics" or "I'm only looking for private practice."
And, you know, that isn't the case for all of us.

Dr. Suzanne Cole: Yeah, and I'll tell you, I felt like pretty on
my own because I was in an incredibly academic environment. I was
kind of the only fellow that I was aware of at that time that was
saying, "I'm planning on going back into the community and not into
academia." And so, you know, everyone around me as far as faculty
members like really couldn't mentor me or help me navigate how to
do that well.

Dr. Suzanne Cole: And so in my second year of fellowship, I
actually started looking for jobs at that time. And my husband and
I were kind of looking possibly to go back to Dallas. But at that
time, this was in like the 2008 economic crash that was going on.
And because I had done my residency at UT Southwestern, I had a lot
of friends who were in practice in Dallas and in that community.
And the jobs were just drying up.

Dr. Suzanne Cole: Like a lot of the private practice or
community oncology programs were just not sure financially what was
happening nationally. And so they weren't putting out new jobs
because they weren't sure that they would be able to support
bringing on another partner. And so when I realized that the Dallas
market was not looking like a feasible option, I kind of thought,
"Well, look, you know, I don't really have any ties to anywhere
else. I'm going to cast a very wide net and I'll look, you know,
from California to Maine and just see what's the best opportunity
for me to get my loans taken care of and to get into a good group
where I have like a feeling of mentorship from colleagues and a
good vibe from the team."

Dr. Suzanne Cole: And I started looking at just kind of all
kinds of random opportunities across the United States. And, you
know, to be quite honest, when the West Virginia job came onto my
radar, I thought, "Mm, you know, it's West Virginia. I don't have
any connection to that place. You know, I'm not sure that this is
going to be, like, Option A, B, C, or E, but it might be Option
F."

Dr. Suzanne Cole: And then I went out to interview and I just, I
really loved the people. I was actually quite impressed by the
scale of their operation. I had trained at Parkland in Dallas for
my residency. And so I was used to this kind of hospital system
that was caring for underserved populations.

Dr. Suzanne Cole: And what I found very attractive about it was
that in that hospital system, if you needed a cardiothoracic
surgeon, if you needed interventional radiology, if you needed a GI
endoscopist who could do stents or interventional things, those
things were all in place. And so it was kind of the size of the
system that was attractive to me, but then also the partners that I
interviewed that lured me to kind of think about that job. And then
I went for a second interview.

Dr. Suzanne Cole: And it came to the top of the list just
because of the whole package. But it was a real leap of faith to
pack up my family and move across the country by ourselves to, you
know, a very remote part of the country where we didn't have a lot
of support either from friends or family. And we were just kind of
loners showing up in this city together.

Dr. Suzanne Cole: But it worked out. And it was I think it was
one of the best decisions that I've ever made because I was able to
like become very independent as a practitioner and really feel
confident that I could handle anything that came through the door.
And then it also just kind of launched my research career in
community practice, which is not something that's easy to find or
carve out for yourself. And so I just felt like it was a very
fortuitous way everything came together.

Dr. Miriam Knoll: Can you tell us about your transition to UT
Southwestern?

Dr. Suzanne Cole: So there was a little bit of a break in the
middle of that. As my younger children were approaching elementary
school, we started looking to try and get closer to Texas where
both my husband and my family are in Texas. And so about four years
after I had been in West Virginia, we started looking back in
Dallas again.

Dr. Suzanne Cole: And, again, kind of the job market was still
not where I was-- there was nothing there that was kind of
interesting to me as far as having the clinical research component,
but also general community practice. And so I kind of widened my
scope again and found a job in Oklahoma City at Mercy Hospital
where they also have this very robust community practice, I had
multiple partners, and a very strong community-based clinical
research program. And Oklahoma City is about three hours from
Dallas.

Dr. Suzanne Cole: And so it was not that far from my family. So
we decided to take that position. And we settled in Oklahoma and
stayed there for four years. And I thought I would probably never
leave. I was, you know, very happy. My job was really good.

Dr. Suzanne Cole: And then I got this flyer in the mail. It was
like a super random thing where I get home from work one day and
I'm kind of going through the junk mail. And there is this flier
advertising UT Southwestern Community Oncology Practice in North
Dallas, have access to over 300 clinical trials, you know, be
connected to the university, but be embedded in your community.

Dr. Suzanne Cole: And, you know, I have like this huge
allegiance and great love and respect for you UT Southwestern,
which is where I did my medical school and residency. And it's a
job in Dallas that is kind of-- if I could dream up on paper
exactly what I would see myself doing for the rest of my life in a
kind of hybrid setting, that was kind of what was on this flyer.
And I told my husband, I was like, "I'm just going to like send
them my CV and see what happens. I'm sure nothing will come of
it."

Dr. Suzanne Cole: But they called me the next day. And I came to
interview like maybe a week or two later. And it was just this kind
of perfect fit. Because they really needed somebody who could do
all of the cancers, benign hematology, you know, would be able to
see anything that walks through the door in the community. But they
also were looking for somebody that had kind of an academic mind as
far as thinking about how to get clinical trials available to the
patients, collaborating with the main campus, being part of tumor
boards and presenting patients, and, you know, kind of leveraging
the strengths of a University within the community practice. And I
think like if I had written down my dream job, every kind of point
that I wanted, you know, on paper, that is what has come to pass in
the last year and a half that I've been here.

Dr. Miriam Knoll: Wow, that's really an amazing story. And
thanks so much for sharing it with us. Dr. Cole, I wanted to ask
you about your story about founding the hematology and oncology
women's Facebook group, renamed the HEME/ONC Wolf Pack group after
Abby Wambach's Barnard commencement address in 2018. So, of course,
I'm a member of the group. And can you tell us, what were you
thinking when you started the group? And were you thinking about it
from a social perspective, from a career perspective? And what
would you tell other oncologists who are thinking about potentially
getting involved in social media?

Dr. Suzanne Cole: So I think that the social media stuff
happened to me by accident. I mean, I was kind of like a partaker
of social media. I used Facebook to stay in touch with family and
friends. And I would say it was probably five years ago now that--
it might have been six-- the physician mother's group came about.
And I don't know why, but for some reason I got added to that group
when it was very young and very small.

Dr. Suzanne Cole: And I remember kind of seeing posts on the
physician mother's group, which is now-- I don't how many people
are on it. But it's probably close to 100,000 women physicians
across the world. When I was first part of that, it was maybe 5,000
people were on the site. And I remember seeing a colleague of mine
in Oklahoma City, who was an ER doctor, make a comment that, you
know, on the physician mothers group ER subgroup, they had
discussed this issue about emergency medicine.

Dr. Suzanne Cole: And I thought, wow, is there like a HEME/ONC
group that I could join? Because I would love to talk with other
women about issues that are specific to hematology and oncology.
And the response that I got from the masses was that, you know,
nobody was aware that there was any kind of physician mothers'
group that had a HEME/ONC subset. And so I just decided to start
one that day.

Dr. Suzanne Cole: And when I reached out to Hala who runs PMG
she said, you know, we don't sanction any official physician mother
group subgroups. And so if you want to make a HEME/ONC group,
that's fine. But it'll be kind of separate from the PMG
platform.

Dr. Suzanne Cole: And so I just basically went through my friend
list and added every woman physician that I could think of that was
on Facebook with me. And we probably started with like 25 people.
And it has grown into this really amazing network, support,
resource. You know, I'd say that the thing that people use it the
most for is for advice on de-identified cases.

Dr. Suzanne Cole: You know, somebody posts a case about, "I have
a lady with breast cancer and she's been through these three lines
of therapy and, you know, she's progressing in this way, what would
you say would be the next step?" And what I also find very cool
about our group is that we have multiple experts in particular
fields who will kind of weigh in and point out clinical trials that
may be available or say, you know, in that situation, I would kind
of reach for this drug next. And it's been also just very
supportive from, like, a human being perspective.

Dr. Suzanne Cole: Just because, you know, we have patients that
are critically ill. And we're constantly dealing with sad things
happening to patients that we really care about. And it's become a
little bit of a safe space for physicians to kind of say, "Hey, you
know, one of my favorite patients died and today and I'm just
feeling really torn up about that" and get a whole lot of support
from people all across the world that identify with that. And just
you don't have to explain it. Everybody understands where you're
coming from.

Dr. Miriam Knoll: Yeah, I've personally seen both those things
firsthand and been a beneficiary of that. So and I think there is
even more support that people can find, both in terms of job
opportunities, job advice, you know, how to set up your clinic, you
know, the electronic medical record, negotiating salary, right?
Have you seen posts like that too?

Dr. Suzanne Cole: I feel like very recently there was a post
about a woman who found out that her junior colleague was being
paid, like, twice as much as she was. He was taking less call. You
know, he had constructed his contract in a way that was very
beneficial to him.

Dr. Suzanne Cole: And when she brought it to the attention of
her employers, they kind of were like, "So, you know, what are you
going to do about it?" And by her just kind of putting that
situation out there to us, she got so much feedback from the group
about like, "This is not acceptable. You know, there are all these
other opportunities. You can be paid fairly. You can be
valued."

Dr. Suzanne Cole: And within, I want to say, like two months,
she had a different job. You know, she was like, "I don't have to
put up with this because I'm not alone." and it was really cool to
see that happen for somebody.

Dr. Miriam Knoll: That rallying around, right?

Dr. Suzanne Cole: Yeah, yeah.

Dr. Miriam Knoll: Even though it's virtual.

Dr. Suzanne Cole: It's virtual, but it's real, you know? And
it's I think also the networking that goes on. Like I just, I know
so many people who have given talks at different institutions who
have had opportunities, you know, just kind of presented on our
Facebook group. And they've snatched up the opportunity to be part
of that. And it has helped them grow their network and their
academic credentials. There's just a lot of things that could
happen out of this if you are engaged and you take advantage of
it.

Dr. Miriam Knoll: So how can somebody join the group if they're
not in it yet?

Dr. Suzanne Cole: So because we are a private group, you have to
know somebody who's already a member. And they need to kind
nominate you to join the group. And then we verify that you are a
physician in some type of hematology, oncology field. And we take
HEME/ONC doctors, palliative care, surgeons, there's some
dermatologists that specialize in skin cancers.

Dr. Suzanne Cole: And so anybody who takes care of cancer
patients or does hematology is welcome to join. And the
requirements are, you have to be a physician, you have to be a
woman. And we vet everybody to make sure that they are who they say
they are. And then they are added in.

Dr. Miriam Knoll: And radiation oncologists, right?

Dr. Suzanne Cole: Oh, yes, radiation, definitely.

Dr. Miriam Knoll: Don't forget about us. And actually now there
is a separate radiation oncology women's Facebook group too. So if
any listeners want to join that group, that's actually a group that
grew out of the HEME/ONC group.

Dr. Suzanne Cole: Yes, and there's also a pediatric hematology
oncology subgroup that has kind of split off. And we still have all
of those members as part of the bigger group, but I love that
there's an opportunity for people to network with each other and
discuss things that are particular to their subspecialties.

Dr. Suzanne Cole: I think the worst career advice is to do what
your-- what everyone around you is doing. I think there's like an
incredible pressure when you're in training to conform to what is
expected and to sometimes ignore those inner voices that are
telling you, you know, "Hey, maybe this is not the right fit for
me." I personally have always really struggled with writing. Like I
don't enjoy it.

Dr. Suzanne Cole: I love clinical medicine. I love seeing
patients. I love participating in clinical trials. But I don't
totally love writing them. So I think being browbeaten into pushing
down a pathway that doesn't feel inspiring to you could be very,
very detrimental to your long-term career.

Dr. Miriam Knoll: What's the best career advice you've
gotten?

Dr. Suzanne Cole: So the best career advice I've gotten is know
yourself and even if you're scared, go for it if you are excited
and feel a passionate interest in something that may be a little
off the beaten path.

Dr. Miriam Knoll: And last question for you this morning, what
advice would you give to trainees and early career oncologists?

Dr. Suzanne Cole: So I would say really take time during your
training and in the first one to two years that you're out of
training to figure out who you are as a physician and what makes
you happy. Because if you can find something that is setting you on
fire, you're so passionate about this particular thing, it can
carry you through the harder stuff that we all have to deal with
throughout our careers.

Dr. Suzanne Cole: So also to seek out different options. If you
have, you know, an interest in community practice but you're not
really exposed to it as is usual in a fellowship-type program,
network and connect and try to speak with other people who are
practicing in a place that you think, "I might be happy in this
place." And you really need to talk to people who are doing it.

Dr. Miriam Knoll: Dr. Cole, thank you so much for joining me
this morning and for this amazing discussion. And thank you to our
listeners for joining us for this episode of the ASCO Daily News
Podcast. We'd love to have your feedback so please drop us a note
at dailynews@asco.org. And rate and review us on Apple
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The purpose of this podcast is to educate and to inform. This is
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About the Podcast

The ASCO Daily News Podcast features oncologists discussing the latest research and therapies in their areas of expertise.